PALS Exam Questions and Answers 2025: A Comprehensive Review, Exams of Pediatrics

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PALS Exam Questions and Answers 2025

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You are caring for a child who was resuscitated after a drowning event. The child is intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is slow and the monitor shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and the central pulses are weak. Intravenous access has been established. The core temperature is 37.3oC. Based on the PALS bradycardia algorithm, which of the following should be provided first? Epinephrine IV Transcutaneous pacing Atropine IV Dobutamine IV infusion correct answer Epinephrine IV You are caring for a 5-year-old patient with supraventricular tachycardia (heart rate = 220/min). The child is lethargic. The skin is pale and cool with delayed capillary refill. Distal pulses are not palpable. Which of the following would be the best treatment to provide without delay? Place cold packs on the distal upper and lower extremities Ask the child to blow through a small straw Exert light pressure on the eyes bilaterally Provide synchronized cardioversion at 0.5 to 1 J/kg correct answer Provide synchronized cardioversion at 0.5 to 1 J/kg You are initiating treatment for a child with septic shock and hypotension. While administering high-flow oxygen you determine that the child's respirations are adequate and SpO2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion?

falls to 6/min with significant intercostals retractions, and little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following treatments would be best for you to provide now? Administer epinephrine IV Provide bag-mask ventilation Administer magnesium sulfate IV Intubate and ventilate correct answer Provide bag-mask ventilation Which of the following is likely to be the most helpful technique to identify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest? Obtaining a urine sample for toxicology screen Obtaining chest and abdominal radiographs Soliciting a history from the caregiver or family Obtaining a venous blood gas correct answer Soliciting a history from the caregiver or family You are caring for a patient who developed a tension pneumothorax after several hours of positive- pressure ventilation. Which of the following would be the most appropriate site for needle decompression? Over the third rib at the midclavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line correct answer Over the third rib at the midclavicular line You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following should you attempt

now?

You are treating a 10-year-old patient after a motor vehicle crash. The patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an SPO2 of 95% and good chest excursion bilaterally. The blood pressure is 130/70 mm Hg, and the heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time? Obtain a CT scan of the head and neck Begin manual hyperventilation Provide continuous positive airway pressure Give an intravenous bolus of mannitol correct answer Obtain a CT scan of the head and neck You arrive on the scene of a 12-year-old child who suddenly collapsed on the playground. The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer just brought the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next? Obtain intravenous access Attempt defibrillation Change compressions:ventilations from 30:2 to 15: Attempt endotracheal intubation correct answer Attempt defibrillation You are caring for a child in persistent ventricular fibrillation. Which of the following would best describe the child's cardiac condition? The heart is not pumping blood at all The heart is beating too slowly to maintain circulation There is no electrical activity in the heart

The heart is pumping so fast that it cannot fill completely between beats correct answerThe heart is not pumping blood at all You are called to treat a 5-year-old with a 3-day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/min and regular with poor capillary refill. You provide bag-mask ventilations (BMV) with high-flow oxygen that produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first? Perform transcutaneous pacing Administer epinephrine IV Administer atropine IV Resume bag-mask ventilation correct answer Resume bag-mask ventilation You are caring for an 8-month-old with bradycardia and very poor perfusion that has persisted despite effective ventilations with high-flow oxygen. You should begin chest compressions if the heart rate is: More than 200/min More than 150/min Less than 100/min Less than 60/min correct answer Less than 60/min You are caring for a 2-year-old with a 1-day history of respiratory distress and stridor. The patient is alert. The child's respiratory rate is 32/min with good chest rise. SPO2 is 98% in room air. The heart rate is 128/min and capillary refill is normal. Skin is warm, pink, and dry. At this point you should: Assist ventilations with bag-mask device Use a nonrebreathing mask with tight mask seal

Localization of a painful stimulus correct answer Localization of a painful stimulus You are caring for an 8-year-old child who was struck by a car. The child is alert, very anxious, and in respiratory distress. The child is receiving high-flow oxygen by face mask, has a respiratory rate of 60/min, the heart rate is 150/min, systolic blood pressure is 70 mm Hg, and a SpO2 of 86% and falling. Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely cause of this child's distress? Tension Pneumothorax Cardiac temponade Severe hypovolemia Cardiac asthma correct answer Tension Pneumothorax You are treating a 10-year-old victim of multisystem trauma. The child is very anxious and confused. The respiratory rate is 44/min and unlabored. the pulse is rapid and weak. Capillary refill is delayed. High- flow oxygen and an intravenous line are in place. The most appropriate initial fluid for rapid volume expansion is: 10% dextrose in water 5% dextrose in Ringer's lactate 5% dextrose in normal saline Normal saline or Ringer's lactate correct answerNormal saline or Ringer's lactate When monitoring the quality of chest compressions during a resuscitation, you should ensure that providers are: Pushing hard - ensure that the chest is compressed 3/4 of the anterior-posterior diameter Pushing fast - compress at a rate of 150/min Allowing complete recoil - let the chest return to its original position between compressions

Minimizing interruptions - do not permit interruptions for more than 1 minute correct answerAllowing complete recoil - let the chest return to its original position between compressions You are treating an 8-year-old with ventricular tachycardia (VT) with pulses and adequate perfusion. You attempted synchronized cardioversion without success. While seeking expert consultation, it would be most appropriate to: Administer a loading dose of milrinone Initiate overdrive pacing transcutaneously Consider possible metabolic and toxicologic causes Deliver an unsynchronized shock correct answerConsider possible metabolic and toxicologic causes You are caring for a patient who developed a tension pneumothorax after several hours of positive- pressure ventilation. Which of the following would be the most appropriate site for needle decompression? Over the third rib (ie, second intercostal space) at the mid-clavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line correct answerOver the third rib (ie, second intercostal space) at the mid-clavicular line You are initiating treatment for a child with septic shock and hypotension. While administering high-flow oxygen, you determine that the child's respirations are adequate and SpO2 is 100%. You have just established vascular access and obtained blood samples. Which of the following is the next most appropriate therapy to support systemic perfusion? Administer repeated fluid boluses of isotonic colloidge Administer repeated fluid boluses of isotonic crystalloid

Increasing tidal volume Increasing positive end-expiratory pressure (PEEP) correct answerUsing a resuscitation bag to provide manual ventilation with 100% oxygen You are caring for a 9-month-old patient with pronounced respiratory distress. You initiated high-flow oxygen using a nonrebreathing mask about 10 minutes ago and established intravenous access. Initially the infant's heart rate was in the 150/min range with strong pulses. Suddenly the infant's respiratory rate falls to 6/min with significant intercostal retractions, and little air movement is heard. The infant becomes cyanotic and the heart rate decreases to 95/min. Which of the following treatments would be best for you to provide now? Administer epinephrine IV Provide bag-mask ventilation Administer magnesium sulfate IV lntubate and ventilate correct answerProvide bag-mask ventilation You are caring for an 8-year-old child who was struck by a car. The child is alert, very anxious, and in respiratory distress. The child is receiving high-flow oxygen by face mask, has a respiratory rate of 60/min, heart rate of 150/min, systolic blood pressure of 70 mm Hg, and Spot of 86% and falling. Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely cause of this child's distress? Cardiac tamponade Severe hypovolemia Tension pneumothorax Cardiac asthma correct answerTension pneumothorax Which of the following is likely to be the most helpful technique to identify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest?

Soliciting a history from the caregiver or family Obtaining a urine sample for toxicology screen Obtaining chest and abdominal radiographs Obtaining a venous blood gas correct answerSoliciting a history from the caregiver or family Which of the following rhythms is shown on this ECG rhythm strip? Sinus bradycardia Ventricular fibrillation (VF) Asystole Supraventricular tachycardia) correct answerVentricular fibrillation (VF) You are caring for an 8-month-old with bradycardia and very poor perfusion that has persisted despite effective ventilations with high-flow oxygen. You should begin chest compressions if the heart rate is: More than 200/min More than 150/min Less than 100/min Less than 60/min correct answerLess than 60/min You are caring for a 3-year-old with myocarditis and heart failure. She has become poorly responsive to a sternal rub and is difficult to rouse. She has a sinus rhythm with a heart rate of 175/min, and a blood pressure of 88/65 mm Hg. Her skin is cool and mottled, capillary refill time is 5 seconds and she has barely palpable distal pulses. Oxygen saturation is 90% on high-flow, high-concentration oxygen by face mask. Her respirations are labored at 50/min with moderate retractions, and crackles are heard at the bases. Which of the following would be the most appropriate therapy for this child? Obtain a STAT echocardiogram and chest x-ray

confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an Spot of 95% and good chest excursion bilaterally. Blood pressure is 130/70 mm Hg and heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time? Give an intravenous bolus of mannitol Provide continuous positive airway pressure (CPAP) Obtain a CT scan of the head and neck Begin manual hyperventilation correct answerObtain a CT scan of the head and neck You arrive on the scene where a 12-year-old child has suddenly collapsed on the playground. The child is unresponsive, apneic, and pulseless, and CPR is in progress. A lay rescuer just arrived with the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next? Attempt endotracheal intubation Obtain intravenous access Attempt defibrillation Change the compression-to-ventilation ratio from 30:2 to 15:2 correct answerAttempt defibrillation You are caring for a child in persistent VF. Which of the following would best describe the child's cardiac condition? The heart is not pumping blood at all The heart is beating too slowly to maintain circulation There is no electrical activity in the heart The heart is pumping so fast that it cannot fill completely between beats correct answerThe heart is not pumping blood at all

You are called to treat a 5-year-old with a 3-day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/min and regular with poor capillary refill. You provide bag-mask ventilation with high-flow oxygen, which produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first? Perform transcutaneous pacing Resume bag-mask ventilation Administer epinephrine IV Administer atropine IV correct answerResume bag-mask ventilation You are caring for a 7-year-old with respiratory distress that has worsened over the past few hours. The child is alert and in moderate respiratory distress with prolonged exhalation time. The respiratory rate is 28/min with bilateral expiratory wheezes. The heart rate is 112/min with good capillary refill. The wheezing in this patient indicates: Disordered control of breathing Lung tissue (parenchymal) lung disease Lower airway obstruction Upper airway obstruction correct answerLower airway obstruction Which of the following assessments is most useful in evaluating the effectiveness of bagmask ventilation? Hearing an air leak around the mask when the bag is fully compressed Seeing the abdomen rise during ventilationcation Observation of visible chest rise A normal systolic, diastolic, and mean arterial pressure correct answerObservation of visible chest rise

You are caring for a child who was resuscitated after a drowning event. The child is intubated and ventilated with 100% oxygen with equal breath sounds and exhaled CO2 detected. The heart rate is slow and the monitor shows a sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and central pulses are weak. Intravenous access has been established. The core temperature is 37.3°C. Based on the PALS bradycardia algorithm, which of the following should be provided first? Transcutaneous pacing Epinephrine IV Atropine IV Dobutamine IV infusion correct answerEpinephrine IV You are caring for a 2-year-old with a 1-day history of respiratory distress and stridor. The patient is alert. The child's respiratory rate is 32/min with good chest rise. Spot is 98% in room air. The heart rate is 128/min and capillary refill is normal. Skin is warm, pink, and dry. At this point you should: Keep the patient calm and comfortable Assist ventilations with a bag-mask devicecation Give IV methylprednisolone (Solumedrol) Use a nonrebreathing mask with a tight mask seal correct answerKeep the patient calm and comfortable